﻿<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="utf-8" content="">
    <title>Request for Payment</title>
    <link rel="stylesheet" href="{STYLE}?v=1.2320" type="text/css" media="screen" />
</head>
<body>
    <div class="container-fluid">
        <div class="row-fluid">
            <div class="span9">
                <div class="row-fluid">
                    <div class="span3">
                        <div style="border: 1px solid #000; padding: 10px; text-align: center;">
                            {VOUCHER_NO.}</div>
                        <p style="text-align: center;">
                            Payment Voucher No.</p>
                    </div>
                    <div class="span9">
                        <h2 class="central" style="text-decoration: underline;">
                            Request for Payment
                        </h2>
                        <h4 class="central" style="color: Red;">
                            No.: {REQ_NO.}</h4>
                    </div>
                </div>
                <table class="summary default black-borders" style="margin-top: 20px;">
                    <tbody>
                        <tr>
                            <td class="blue">
                                PO No.:
                            </td>
                            <td class="blue">
                                Date
                            </td>
                            <td class="blue">
                                Currency
                            </td>
                        </tr>
                        <tr>
                            <td align="center">
                                {POSPMNO.}
                            </td>
                            <td align="center">
                                {DATE}
                            </td>
                            <td align="center">
                                {CURRENCY}
                            </td>
                        </tr>
                        <tr>
                            <td class="blue">
                                Payment Terms:
                            </td>
                            <td class="blue">
                                Payment Type:
                            </td>
                            <td class="blue">
                                Total Payment:
                            </td>
                        </tr>
                        <tr>
                            <td align="center">
                                {PAYMENT_TERMS}
                            </td>
                            <td align="center">
                                {PAYMENT_TYPE}
                            </td>
                            <td align="center">
                                {TOTAL_PAYMENT}
                            </td>
                        </tr>
                    </tbody>
                </table>
            </div>
            <div class="span3">
                <table>
                    <tbody>
                        <tr>
                            <td>
                                <img src="{LOGO1}" alt="" />
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <img src="{LOGO2}" alt="" />
                            </td>
                        </tr>
                        <tr>
                            <td>
                                DANISH REFUGEE COUNCIL
                                <br />
                                Borgergade 10
                                <br />
                                DK-1300 Copenhagen
                                <br />
                                Denmark
                                <br />
                            </td>
                        </tr>
                        <tr>
                            <td style="padding-top: 5px;">
                                COUNTRY OFFICE, UGANDA
                                <br />
                                4688 Kalungi Road
                                <br />
                                Muyenga, Kampala
                                <br />
                            </td>
                        </tr>
                        <tr>
                            <td>
                                <a href="http://WWW.drc.dk">WWW.drc.dk </a>
                                <br />
                                <a href="http://WWW.danishdemininggroup.dk">www.danishdemininggroup.dk </a>
                            </td>
                        </tr>
                    </tbody>
                </table>
            </div>
        </div>
        <div class="row-fluid">
            <div class="span12">
                <table class="black-borders default" style="margin: 10px 0;">
                    <tbody>
                        <tr>
                            <td class="blue" style="width: 25%">
                                <b>Subject/Purpose:</b>
                            </td>
                            <td colspan="4">
                                {SUBJECT}
                            </td>
                        </tr>
                        <tr>
                            <td class="blue" style="width: 25%;">
                                <b>Payment to:</b>
                            </td>
                            <td colspan="4">
                                {PAYMENT_TO}
                            </td>
                        </tr>
                        <tr>
                            <td class="blue" style="width: 25%;">
                                <b>Request for:</b>
                            </td>
                            <td class="choice-font">
                                <input type="radio" value="{CHOICE_FP}" />
                                &nbsp;&nbsp;Full Payament
                            </td>
                            <td class="choice-font">
                                <input type="radio" value="{CHOICE_RI}" />
                                &nbsp;&nbsp;Rate/Instalment
                            </td>
                            <td class="choice-font">
                                <input type="radio" value="{CHOICE_AP}" />
                                &nbsp;&nbsp;Adv. Payment %
                            </td>
                            <td class="choice-font">
                                <input type="radio" value="{CHOICE_AFP}" />
                                &nbsp;&nbsp;Adv. Final Payment %
                            </td>
                        </tr>
                    </tbody>
                </table>
            </div>
        </div>
        <br />
        <div class="row-fluid">
            <div class="span12">
                <table align="center" cellspacing="0" cellpadding="0" border="1" style="border: 1px solid grey;
                    border-collapse: collapse; padding: 5px; font-size: 12px;" class="goods-detail">
                    <thead>
                        <tr>
                            <th colspan="5" style="text-align: left;">
                                <b>Payment Details</b>
                            </th>
                        </tr>
                        <tr class="bald">
                            <th align="center">
                                No.
                            </th>
                            <th>
                                Project No.
                            </th>
                            <th>
                                Budget Line
                            </th>
                            <th>
                                Amount
                            </th>
                            <th>
                                Currency
                            </th>
                        </tr>
                    </thead>
                    <tbody>
                        {PAYMENT_DETAILS}
                    </tbody>
                </table>
            </div>
        </div>
        <br />
        <div class="row-fluid">
            <div class="span12">
                <table align="center" cellspacing="0" cellpadding="0" border="1" style="border: 1px solid grey;
                    border-collapse: collapse; padding: 5px; font-size: 12px;" class="goods-detail">
                    <tbody>
                        <tr>
                            <td colspan="5">
                                <b style="color: #31849b; font-size: 1.2em;">Supporting Documents in tender/payment
                                    dossier</b><br />
                            </td>
                        </tr>
                        <tr>
                            <td colspan="5">
                                Remarks:<br />
                                {REMARKS}
                            </td>
                        </tr>
                        <tr>
                            <th style="width: 45%;" class="grey-2">
                                <b>Master Budget Currency</b>
                            </th>
                            <td>
                                {MB_CURRENCY}
                            </td>
                            <th class="grey-2">
                                Total
                            </th>
                            <td>
                                {TOTAL}
                            </td>
                            <th>
                                <b>Request For Payment Value</b>
                            </th>
                        </tr>
                    </tbody>
                </table>
            </div>
        </div>
        <br />
        <div class="row-fluid">
            <div class="span12">
                <table class="black-borders default" style="margin: 10px 0;">
                    <tbody>
                        <tr>
                            <td class="central" style="width: 19%;">
                                <b style="text-decoration: underline;">Authorization</b>
                            </td>
                            <td class="central blue">
                                RFP Prepared by
                            </td>
                            <td class="central blue">
                                Finance Review/Approval of BL/PN
                            </td>
                            <td class="central blue">
                                RFP Authorized by Manager/CD
                            </td>
                        </tr>
                        <tr>
                            <td class="blue">
                                Name
                            </td>
                            <td>
                                {PREPAROR_NAME}
                            </td>
                            <td>
                                {REVIEWER_NAME}
                            </td>
                            <td>
                                {AUTHORIZER_NAME}
                            </td>
                        </tr>
                        <tr>
                            <td class="blue">
                                Title
                            </td>
                            <td>
                                {PREPAROR_TITLE}
                            </td>
                            <td>
                                {REVIEWER_TITLE}
                            </td>
                            <td>
                                {AUTHORIZER_TITLE}
                            </td>
                        </tr>
                        <tr>
                            <td class="blue">
                                Date
                            </td>
                            <td>
                                {PREPAROR_DATE}
                            </td>
                            <td>
                                {REVIEWER_DATE}
                            </td>
                            <td>
                                {AUTHORIZER_DATE}
                            </td>
                        </tr>
                        <tr>
                            <td class="blue">
                                Signature
                            </td>
                            <td>
                                {PREPAROR_SIG}
                            </td>
                            <td>
                                {REVIEWER_SIG}
                            </td>
                            <td>
                                {AUTHORIZER_SIG}
                            </td>
                        </tr>
                    </tbody>
                </table>
            </div>
        </div>
    </div>
</body>
</html>
